RGA Request Form

Date:

-- mm/dd/yy

Contact Info:

Name
Title
Organization
Work Phone
FAX
E-mail
URL

Customer Number (Please see packing slip):

Invoice Number (Please See Packing Slip):

Was the merchandise signed for damaged?

Yes No

Please describe the damage:

Is the merchandise useable?

Yes No

Did you order the wrong merchandise?

Yes No

Did you receive the wrong merchandise?

Yes No

Were items missing from your order?

Yes No

What items were missing?

What would your ideal resolution be?

Please select from the following:

I would like to return & reorder.
I would like to return for credit only.
Not sure
other

Other reason